Healthcare Provider Details

I. General information

NPI: 1083845291
Provider Name (Legal Business Name): MOBILE DOCTORS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27620 FARMINGTON RD STE 109
FARMINGTON HILLS MI
48334-3367
US

IV. Provider business mailing address

27620 FARMINGTON RD STE 109
FARMINGTON HILLS MI
48334-3367
US

V. Phone/Fax

Practice location:
  • Phone: 248-840-7480
  • Fax: 800-660-6187
Mailing address:
  • Phone: 248-840-7480
  • Fax: 800-660-6187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301032562
License Number StateMI

VIII. Authorized Official

Name: SONJAI POONPANIJ
Title or Position: OWNER
Credential: MD
Phone: 248-840-7470